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General NPI Number Information
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NPI Number | 1538085642
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Entity Type | Individual
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Provider Name | LOGAN ROBERTSON PLMSW
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Gender | Male
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 2928 N MCKEE CIR STE 119
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3465
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Country | US
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Telephone | 479-995-2767
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 SE WALTON BLVD STE 219
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City | BENTONVILLE
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State | AR
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Zip | 72712-3750
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Country | US
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Telephone | 479-995-2767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PLMSW
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License Number State | AR
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